HOSPITAL STAYS ARE SHORTER, A CONCERN

Palm Beach County hospitals are faced with a frustrating paradox: While more and more patients are being admitted to local hospitals, occupancy rates are dropping dramatically.

The drop in occupancy rates has forced at least three county hospitals to lay off nurses, technicians and other workers and scramble to find new ways to make money and cut costs.

"I'm hearing from all the hospital administrators (that), for the first time, they are all extremely cost-conscious," said Edward Holloway, executive director of the District Nine Health Council in West Palm Beach.

Holloway's agency, which provides health planning for Palm Beach County, has just released new statistics showing that from 1983 and 1984, seven of the 13 hospitals in the county saw a slight increase in the number of patients they admitted.

But, during the same period, eight county hospitals experienced a decline in occupancy.

The reason for the paradox is that the average patient is spending much less time in the hospital. The average length of stay in hospitals in the southern part of the county, for example, dropped almost a full day in the past year, from 7.7 days in 1983 to 6.8 days in 1984, according to the Health Council.

Holloway said several trends account for the shorter hospital stays:

(BU) Medicare regulations that went into effect late in 1983 limited the number of days of hospital treatment that the federal insurance program for the elderly will reimburse. Almost half the hospital patients in the county are on Medicare.

(BU) Advances in medical technology and demands by insurance companies have made less costly outpatient, or same-day, surgery much more common in the past year. The number of outpatient surgical procedures increased 34 percent in the past year and now account for about 22 percent of all the surgery performed in the county.

(BU) Health maintenance organizations, which enroll thousands of elderly people in the county, place increased emphasis on preventive care and admit as few patients as possible to hospitals.

Holloway predicted that these trends are going to cause financial problems for local hospitals for at least five years as they adjust. Empty beds already have forced cutbacks in staff at several local hospitals since the new Medicare regulations went into force:

(BU) Humana Hospital Palm Beaches in West Palm Beach laid off 25 of its 420 workers last month following what officials there called a "drastic" decline in its patient census. The number of patients at the 162-bed hospital had averaged about 140 each day, but, in March, the count plummeted to about 80 patients.

(BU) Declining occupancy levels at St. Mary's Hospital in West Palm Beach last April forced the elimination of about 100 jobs -- amounting to about a 10 percent reduction in its workforce. "We're doing things (now) on a much more efficient basis," said Don Chester of St. Mary's.

(BU) Bethesda Memorial Hospital in Boynton Beach went through two rounds of staff cuts, laying off 26 workers in July 1983 and another 42 workers in January of last year, several months after the hospital fell under the new Medicare rules. Hospital officials said the layoffs were necessary because the hospital was experiencing its first drop in occupancy in its 25-year history.

The problems facing county hospitals are similar to those being experienced by hospitals nationwide. A study released last week by the American Hospital Association found the average hospital stay was shorter in 1984 than the year before.

But, while most hospitals across the country also are admitting fewer patients than in the past, Palm Beach County's growing population caused admissions at local hospitals to increase by 3 percent last year.

"There's a lot a hospital administrators praying for a population boom," Holloway said.

Many hospitals are trying to make money by increasing the amount of outpatient surgery they do or by providing entirely new services.

By October, Bethesda Memorial plans to have a home health agency in operation that will provide nursing services to patients after they are discharged from the hospital, Bill Castles, a hospital spokesman said.

At St. Mary's, outpatient surgery has been increased dramatically, Chester said. A year ago, this kind of surgery accounted for just 7 to 8 percent of the hospital's operations; it now accounts for about 35 percent of operations, he said.